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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien
(Rev. February 2004) Ifs _x.13,1 ?-Ty
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 829-3903
640710510
?Q•DO P?
PUFF
As provided by section 6321, 6322, and 6323 of the Internal Revenue et 97A
Code, we are giving a notice that taxes (including interest and penalties) 0.14039(o
have been assessed against the following-named taxpayer. We have made
a demand for payment of this liability, but It remains unpaid. Therefore,
there is a lien in favor of the united States on all property and rights to
property belonging to this taxpayer for the amount of these taxes, and "
additional
penalties, interest, and costs that may accrue.
_ :n-
T'
Name of Taxpayer GARY K HOLCK -
G1 ,
Residence PO BOX 200
CAMP HILL, PA 17001-0200
IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice of the lien is refiled by the date given in column (e), this notice shall,
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a).
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Wiling of Assessment
(a) (b) (c) (d) e)
1040 12/31/2003 XXX-XX-1884 05/31/2004 06/30/2014 830.95
1040 12/31/2004 XXX-XX-1884 09/18/2006 10/18/2016 2016.31
1040 12/31/2006 XXX-XX-1884 12/15/2008 01/14/2019
1040 12/31/2006 XXX-XX-1884 12/15/2008 01/14/2019 9960.76
1040 12/31/2007 XXX-XX-1884 11/03/2008 12/03/2018 6138.92
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total J$
18946.94
on this,
This notice was prepared and signed at DETROIT, MI
the 02nd day of April 2010
Signature ?- A Yh4&w Title
ACS 22-00-0008
for MICHAEL W. COX (800) 829-3903
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien
Rev. Rul. 71-466, 1971 - 2 C.B. 409)
Part I - Kept By Recording Office CAT. 668(l (Rev. 2-200X)
CAT. NO 60026X